Criteria to Start and Stop Renal Replacement Therapy in Intensive Care Unit

Abstract

Timing of renal replacement therapy (RRT) and criteria for stopping it in acute kidney injury are hot topics. Life-threatening hyperkalemia, acute overload pulmonary edema generating severe hypoxemia and uremic complications (pericarditis and encephalopathy) are the only indisputable emergency RRT criteria. Apart from these situations, two strategies can be discussed: 1) An early RRT strategy allows better control of metabolic disorders but exposes patients to potential adverse effect among which the complications associated with catheter and extracorporeal circulation; 2) A delayed strategy to minimize these risks. The French studies AKIKI and IDEAL-ICU are intended to solve this question.

Once RRT is started, its usefulness should be appreciated daily and clinician should consider its discontinuation as soon as possible. Assessment of renal function during RRT is difficult. In the current state of knowledge, urine output is the best predictor of renal function recovery.